Symptoms and Signs of Psoriasis

Medical Author: John P. Cunha, DO, FACOEP
Medically Reviewed on 11/4/2021

Doctor's Notes on Psoriasis

Psoriasis is a chronic autoimmune skin disorder that causes patchy, red, scaly areas of skin. It typically affects the arms, legs, trunk, scalp, knees, elbows, and lower back but it may occur on any part of the skin. The most common form of psoriasis is called plaque psoriasis (psoriasis vulgaris).

Symptoms of plaque psoriasis include

  • plaques that are red, raised,
  • scaly skin affecting the scalp, elbows, and knees.
  • The plaques may itch or burn.
  • Flares (periods when the condition worsens) may last weeks to months.
  • Plaques may split and bleed, especially when they occur over joints or on the palms or feet.
  • Plaques may be surrounded by a halo or ring of blanched skin (Ring of Woronoff).
  • Skin scales are silvery white and thickness varies.

Other symptoms of psoriasis include

  • nail changes such as discoloration and separation from the nail bed at the fingertip.

In children, symptoms of plaque psoriasis may appear different. Plaques are not as thick and the affected skin is less scaly. Psoriasis often appears in the diaper region in infancy and in flexural areas (underarms, groin, perianal area) and the face in children.

What Is the Treatment for Psoriasis?

There is no cure for psoriasis, but treatments can relieve symptoms and decrease flare-ups.

Medical treatments for psoriasis include: 

  • Topical treatments (on the skin)
    • Over-the-counter (OTC) topical treatments
      • Salicylic acid
      • Coal tar
      • Lotion or cream moisturizers
      • Bath solutions such as oil, oatmeal, Epsom salts 
      • Keratolytics to keep skin cells from building up usually contain an active ingredient of salicylic acid, lactic acid, urea, or phenol 
      • Apply coverings over topical treatments such as plastic wrap, cellophane, waterproof dressing, cotton socks or a nylon suit to keep area moist
      • Anti-itch treatments such as calamine, hydrocortisone, camphor, diphenhydramine (Benadryl)
      • Aloe vera, jojoba
    • Prescription topical treatments
  • Phototherapy (light therapy)
    • Psoralen + UVA (PUVA
    • Ultraviolet light B (UVB): broad band and narrow band
  • Systemic treatments
    • Biologics and biosimilars
      • Tumor necrosis factor-alpha (TNF-alpha) inhibitors such as certolizumab pegol (Cimzia), etanercept (Enbrel), adalimumab (Humira), infliximab (Remicade), golimumab (Simponi and Simponi Aria)
      • Interleukin 12 and 23 (IL-12, IL-23) inhibitors such as ustekinumab (Stelara)
      • Interleukin 17 (IL-17) inhibitors such as secukinumab (Cosentyx), brodalumab (Siliq), and ixekizumab (Taltz)
      • Interleukin 23 (IL-23) inhibitors such as tildrakizumab-asmn (Ilumya), risankizumab-rzaa (Skyrizi), and Tremfya (guselkumab)
      • T-cell inhibitors such as Orencia (abatacept)
      • Biosimilars to adalimumab (Humira): adalimumab-atto (Amjevita), adalimumab-afzb (Abrilada), adalimumab-adbm (Cyltezo), adalimumab-bwwd (Hadlima), adalimumab-fkjp (Hulio), and adalimumab-adaz (Hyrimoz) 
      • Biosimilars to infliximab (Remicade): infliximab-axxq (Avsola), infliximab-dyyb (Inflectra), infliximab-qbtx (Ixifi), and infliximab-abda (Renflexis) 
      • Biosimilars to etanercept (Enbrel): etanercept-szzs (Erelzi) and etanercept-ykro (Eticovo) 
    • Disease-modifying antirheumatic drugs (DMARDs) including tofacitinib (Xeljanz and Xeljanz XR)
    • Traditional oral systemics
    • Nonsteroidal anti-inflammatory drugs (NSAIDs), including aspirin and ibuprofen (Advil, Motrin)

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REFERENCE:

Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.